Reflections on the Human Condition - Api-fellowships.org

200 SESSION III
References: V.A. Bautista. 2002. Challenges
to Sustaining Primary Health Care in the
Philippines. Public Policy 2(2):89-128; M.E.
Atienza. 2004. The Politics of Health Devolution
in the Philippines. Philippines Political Science
Journal 25(48):25-54.
The net migration of medical doctors and other health
staff from poorer countries to more affluent ones is a
global phenomenon, hardly novel but one which has
emerged as a significant issue in international health
policy circles. 49
Driven in part by escalating demand for nursing care as
the “baby boom” generation ages, recruitment of nurses
especially from countries of the English-speaking South
has accelerated in the last decade. 50
In recent years, the annual exodus of nurses leaving the
Philippines for foreign employment markedly exceeded
the number of trained nurses who were licensed in
those years.
This peaked at 13,536 nurse émigrés in 2001, more
than three times the number of trained nurses who
were licensed in that year (4280), but this outflow had
declined to 8,968 in 2003. Cumulatively, 163,756, or
85% of currently employed Filipino nurses are working
outside of the Philippines, principally in Saudi Arabia,
United States of America, United Kingdom, Libya,
United Arab Emirates, Ireland, Singapore, and Kuwait.
The recruitment by these countries have fluctuated
greatly in the period 1992-2003, with the exception
of Saudi Arabia where recruitment was consistently
high with a recent uptrend perhaps reflecting lower
recruitment from other source countries in the post-
9/11 period. By 2003, Saudi Arabia accounted for
56.8% of Filipino nurses employed abroad . 51
This international mobility of labor evokes divergent
passions:
• Is this a gratifying corrective to the asymmetric
mobility between labor and capital in globalization?
• Or is this depriving a country of scarce, skilled
human resources and thereby exacerbating global
inequity arising from gross imbalances in purchasing
power?
At a HAIAP Regional Seminar on Healthcare Financing
held in Penang on 15 April 2004, Dr. Magdalena
Barcelon, Executive Director of the Community Medicine
Development Foundation (Manila) reported that:
Ref lections on the Human Condition: Change, Conflict and Modernity
The Work of the 2004/2005 API Fellows
“… for the last two years, at least 1,000 or 20
percent of nurses in 11 government hospitals have
gone abroad. At least 50% of health professionals
in government hospitals have pending application
for abroad. Operating rooms are staffed with novice
nurses, and those with experience often work double
shifts. In Jose R. Reyes Memorial and Medical
Center, the flagship hospital of the Department of
Health, 25 out of 30 operating room nurses, or 83
percent, have applied to go abroad. 50% of nursing
staff of Phil Heart Center, National Kidney and
Transplant Institute have left for abroad in the past
few years… Novice nurses now occupy sensitive
posts in the OR, ICU…Deans of nursing schools
all over the country are scrounging for experienced
clinical instructors for replacement to those who
have migrated… Meanwhile, 2,000 medical doctors,
many of them are specialists, have become nurses.
Thousands more have enrolled in colleges that
would give them a nursing degree within one
year. Many have left for abroad, leaving behind
their patients who are in dire need of their care.”
[there are anecdotal reports of other professionals
including lawyers enrolling in nursing colleges]
Interestingly, Dean Baker, 52 co-director of the left-wing
Center for Economic and Policy Research (Washington,
DC), points out (half tongue-in-cheek?) the class bias of
US trade policy negotiators:
Free trade has generally meant removing barriers
on trade in goods, the effect of which is to put
downward pressure on the wages of the three
quarters of the work force without a college degree.
A consistent proponent of “free trade” would also
be arguing strongly for the removal of barriers
to trade in professional services. Putting highly
paid professionals in direct competition with
professionals in developing countries would lead
to large gains to consumers and the economy. In
addition, it would be a more equitable approach
to trade… For the last 50 years, US trade policy
has focused primarily on removing barriers to trade
in goods. Trade policy has not only reduced or
eliminated direct barriers, such as tariffs and quotas;
it has also worked to reduce indirect barriers, such
as rules governing foreign investment, product
safety and environmental standards… However, US
trade negotiators have made no comparable effort to
reduce barriers to trade in highly paid professional
services, such as doctors’, dentists’, lawyers’ and
accountants’ services. To the contrary, in some
cases barriers to foreign professionals working in the
United States have increased in recent years.